Dysphagia is a swallowing disorder, wherein a person is unable to swallow or has difficulty swallowing. Dysphagia is known to affect both adults and children, and can be associated with many acquired and neurogenic disorders, such as stroke, Alzheimer's, Cerebral Palsy, Parkinson disease, head and neck cancer, and traumatic brain injury. Left untreated, dysphagia can cause health complications such as aspiration, malnutrition, dehydration, asphyxia, recurrent respiratory infections, and death.
Dysphagia is diagnosed and managed by clinical professionals, typically speech-language pathologists, who are educated in anatomy and physiology of the oral and pharyngeal mechanisms responsible for deglutition. To diagnose and treat dysphagia, patients are often assessed with a comprehensive swallow examination. The examination may include a case history including a patient or family report, an assessment of oral motor, speech and vocal quality, assessment of respiratory function, and an observation of the patient's ability to chew and swallow varying bolus consistencies and sizes. The presence or absence of Dysphagia is often determined through 1) a clinical swallow evaluation or a bedside swallow evaluation and/or 2) a Videofluroscopic Swallow Study (VFSS) or modified barium swallow study (MBS). A bedside swallow evaluation is typically the first step of a comprehensive swallow examination. The patient is evaluated for signs and symptoms of dysphagia such as choking, coughing, gagging, sneezing, drooling, pocketing of food in cheeks, and/or decreased chewing ability. If any sign or symptom of dysphagia is observed, a VFSS may be completed to provide additional information regarding the swallow function.
A VFSS is generally conducted in a radiology suite by a speech-language pathologist in conjunction with a radiologist. The purpose of the VFSS is to confirm there is a dysfunction in the swallowing mechanism, the type of dysfunction (oral, pharyngeal or combination of both), severity of the swallow dysfunction and whether or not aspiration (taking food and liquid into the lungs) is occurring. Once the diagnosis of dysphagia is made and the type and severity are determined, treatment to remediate and/or compensate for the disorder is initiated. Often, dysphagia is diagnosed and treatment initiated based only on the results of a bedside swallow evaluation.
A typical method for therapeutic management of dysphagia is through modifying the consistency of foods and liquids consumed by dysphagia patients. At present date, diet modification is the most commonly used compensatory strategy to manage patients with dysphagia. Foods are routinely altered by adding a commercial thickening agent or thinned by adding water or other thin liquid. Some examples of commercial thickeners include cornstarch and baby cereal.
Currently, foods for dysphagia patients are generally altered to fall within a pre-established category which is named to resemble an approximated consistency, such as honey thickness, nectar thickness and thin liquids. Classification of the liquids and foods for each of the dysphagia diet categories is based on individual, subjective clinical judgment. The conventional method is problematic due to the inherent inconsistencies and ambiguousness of dysphagia diets. A dysphagia diet typically requires all liquids and foods eaten by the patient to be altered in consistency by blending and/or thickening to prevent adverse health consequences. In current practice, there is no set, uniform measurement to determine or replicate the thickness or consistency of the liquids and foods prescribed to a dysphagia patient.
In current practice, to determine the appropriate consistency that a patient can swallow, a therapist pours foods or liquids into a container, adds water or a commercial thickener, and stirs the mixture until the mixture appears to be the proper consistency that the patient can safely swallow without presenting health risks such as aspiration. More water or thickener is added until the therapist visually estimates whether the consistency is appropriate, using his or her best clinical guess. A therapist also may pour the mixture from a spoon to visually estimate the consistency.
The mixture is then classified into one of predetermined groups, such as (1) “honey” thickness, (2) “nectar” thickness or (3) “thin,” depending on what the mixture consistency most resembles. If a dysphagia diet is prescribed and a liquid consistency is deemed appropriate for the patient, the patient is instructed to drink only one of the predetermined classifications of consistency prescribed, and no other consistency, because other consistencies could be aspirated.
Aspiration can have serious and deadly consequences to a patient's health, such as causing pneumonia, weight loss, fevers, recurrent respiratory illness, or even death. Unfortunately, without a consistent, quantifiable measurement system, the perception of “honey,” “nectar” and “thin” liquids is so variable between people that they are rarely the same. Even the same therapist can mix two separate batches of liquids and foods and have resulting variations in the consistency. For a patient, such variations can be deadly.
Further adding to the problem, dysphagia patients are routinely transferred between medical facilities in clinical care, each with their own guidelines of what constitutes a particular consistency. Routinely, as dysphagia patient's conditions improve, they are transferred to different departments or facilities such as acute care, sub-acute care, rehabilitation facility, long-term (nursing home) care facility or to their home. The potential for problems, in terms of continua of care, increases with each transfer between treatment locations because of variability between caregivers in their perception of food consistencies. A specific technical problem is the inability for a patient or their caregiver to quantifiably replicate the appropriate food consistency prescribed to the patient that would reduce adverse health risks due to their swallow dysfunction.
Current and common methods of treatment include: 1) providing patients with written descriptive diet plans containing examples of recommended foods and liquids, or 2) recommending purchase of a particular commercially prepared product based on its viscosity. Neither of these current treatment methods is optimal. In written descriptive diets, the preparer of the dysphagia diet food and/or liquids are required to estimate the appropriate consistency or viscosity by visually comparing it to another similar food item. In commercially prepared products, manufacturers use different techniques and machinery which are not consistent between manufactures. Consequently, manufacturers of dysphagia food products have different standards of consistency and viscosity, and furthermore, often use the same nomenclature for the categories, such as honey thick, nectar thick or thin liquids. Because of these inconsistencies, the patients may inadvertently consume an inappropriate consistency if they use products from different manufacturers, placing themselves at risk for aspiration or other health consequences.
Presently, there is no technique, procedure or method for clinical professionals, caregivers or patients to independently determine acceptable prescribed foods and liquids based on objective measures.
While the exact number of people suffering from dysphagia is unknown, a sampling survey conducted by the National Center for Health Statistics reported out of 77 million hospitalizations from 2004-2005, 35% were associated with dysphagia.
Accordingly, there is a strong need for a quantitative measurement system that can easily measure food characteristics for dysphagia patients, enabling foods to be reproduced having consistent properties, regardless of the manufacturer, therapist, caregiver or patient preparing the food. There also is a need for dysphagia diets that more precisely meet the specific needs of each dysphagia patient.